Year-end Sale % OFF 
Abstract
BackgroundTo investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with community-acquired pneumonia (CAP) and the association with mortality.MethodsWe assembled a cohort of 1317 adults hospitalized with radiographically confirmed CAP in three Danish hospitals. Patients were grouped into no DNR order, early DNR order (≤48 h after admission), and late DNR order (> 48 h after admission). We tested for associations between a DNR order and mortality using a cox proportional hazard model adjusted for patient and disease related factors.ResultsAmong 1317 patients 177 (13%) patients received a DNR order: 107 (8%) early and 70 (5%) late, during admission. Patients with a DNR order were older (82 years vs. 70 years, p < 0.001), more frequently nursing home residents (41% vs. 6%, p < 0.001) and had more comorbidities (one or more comorbidities: 73% vs. 59%, p < 0.001). The 30-day mortality was 62% and 4% in patients with and without a DNR order, respectively. DNR orders were associated with increased risk of 30-day mortality after adjustment for age, nursing home residency and comorbidities. The association was modified by the CURB-65 score Hazard ratio (HR) 39.3 (95% CI 13.9–110.6), HR 24.0 (95% CI 11.9–48,3) and HR 9.4 (95% CI: 4.7–18.6) for CURB-65 score 0–1, 2 and 3–5, respectively.ConclusionIn this representative Danish cohort, 13% of patients hospitalized with CAP received a DNR order. DNR orders were associated with higher mortality after adjustment for clinical risk factors. Thus, we encourage researcher to take DNR orders into account as potential confounder when reporting CAP associated mortality.
Highlights
To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with communityacquired pneumonia (CAP) and the association with mortality
Of the 1320 patients in the CAP-North cohort, DNR status could be assessed in 1317 patients; three patients were not included due to missing records. 13% (177) had a DNR order; 8% (107) had an early and 5% (70) a late DNR order
Patients with a DNR order were more severely ill (CURB-65 score ≥ 3; 50% vs 13%, p < 0.001) and were more likely to be admitted to the intensive care unit (ICU) (27% vs 7%, p < 0.001), Table 1
Summary
To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with communityacquired pneumonia (CAP) and the association with mortality. Do-not-resuscitate (DNR) orders are among, the most difficult clinical decisions. It is clearly not always in a patient’s best interest to try to prolong a life with severe chronic disease and suffering. A DNR order documents a decision to Community-acquired pneumonia (CAP) is one of the most common infectious diseases in the western world, especially in elderly patients [3,4,5]. From primary to intensive care, will treat patients with CAP [6]. Mortality has been persistently high during the past decades and CAP is still a leading cause of mortality worldwide [4, 7,8,9,10,11].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
